Individual
JESSE B SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 BORTHWICK AVE, PORTSMOUTH, NH 03801-7128
(603) 433-4008
(603) 431-3572
Mailing address
PO BOX 1849, LEWISTOWN, ME 04241-1849
(207) 784-2554
(207) 777-5363
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12765
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01Y008542
ANTHEM BLUE SHIELD OF NH
NH
05
—
30205280
—
NH
Enumeration date
12/01/2006
Last updated
09/25/2012
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